Laserfiche WebLink
FROM TRI VALLEYFAX NO. : 209 957 less eb. 09 2001 12:54PM P2 <br /> Uz« +Uti 1U!Vl ll:4�9 a.b�#4,_ <br /> . FIFTH =LOCR PAGE 62 <br /> Sari Joaquin County Public Health services <br /> Environmental Health ®ivisqicm <br /> Medical Waste tIM26agement Prcgratrl <br /> i <br /> APPLICA7ION FOR A UMI ANTITY HAULING EXMP-MON <br /> To qualTy for a"Limited Quwttty HaLlling Emrnptionr WS 'Ont to tha"'Nled10=Wast* MOUgement Aa", the following <br /> =nditlons must to met: <br /> The generator or health care profestortai genersjas ( tt'' n 20 poems of mec:ieat wasim per week, meports lass <br /> than 2C pounds of rrmodiaa!w=* 7'L ory ene time, maintains a Acing d=rnent pursuant to Chapter 6, and the <br /> garer=r or parent org2s:iz2dan has on 9s ohe of the feffeWri, <br /> 1- ,S�e='iCsl IN3v^te Msttagem�rtt Psn if the ger. r or t Organization is 2 <br /> quantify ganGrator requlred to mgi�r pursuant W hapter a. quantity generator or a small <br /> ?- lnfcfrravon 0=41 "t if the ganeratar or parent brgani=Crl ;s a Z-=l quarstky gerterabar not raciulred to <br /> mister pumtjsnt to CVpter a. <br /> PLEAse camPL-F-m THS INFORMATION SELOW AND�MAIL MTN$67 FEIS TO: <br /> i <br /> San Joaquin County Public Health Services <br /> EnvironmenW Health Division <br /> Medical Waste Management program <br /> 304 E Weber Ave <br /> Stockton, CA 95202 <br /> I <br /> Medical Mats l;iaulor lnformatton <br /> C: New F"ls Renewal <br /> IMadicat Q„calBuslness Name:. TRI' yAT.T.Fv uQm7+ <br /> Medical 0flILe/BL3i mew Address: <br /> City Stockton i State:- CA Code:_ 0520 z <br /> Ccntaot erson: yecl-tom T. Tri-c-vc-rte � .N _�r;mi n; ��,-e rzr PtlQste� r ",n8 <br /> i <br /> storage Facility Name: R I- <br /> .StcrZge Facility/44dress: X37 _BjaS1 v„k•-J;is Gln SLLi a E 2. <br /> City:_ st_"kton Sfia�e:�Zip Ccde:,..rj ?.. <br /> Penritted Treatrr!ent Fa TRY batt O: d <br /> Pe mined matment =acuity Addre S X s t erg <br /> City: O a Ig l a n d _ 1 <br /> —Sts= z _,�zlp CCde; 54601 <br /> fast all employeenames snd dues Ott ;rd to transport the aredfclil waste_ If r=enough spar, attach ittformean. <br /> 1- Name: rUeCita Z i :;LuQrn- hj 'Mile, Me <br /> 2- Name: a d n r n a p;i_ <br /> a . ` - d� � <br /> J - ef1ym deI� rr„� T V Vtarr® a, r, nUnSA iV <br /> TrtSti:�rt t nYLi o�F2...L'13C�1�.�=; =r vrr <br /> ]Dawn Sanders-LVH Ma � <br /> A aepy of ecus�ssem 4*n ood a tmekinv d0a:=,m erica as n ttma eti ,f Nlr, <br /> a4eb w. all 680ea of madcli w4=mcam nMli bo kea an Me xt g® or 1eatjh care lrsnal°a �,r,�y, <br /> Apolicant Signsrure: <br /> i itle' <br /> iDa Nat Write glow This tine <br /> R.E.HS, Application Approval— I date: /L)/ExpFralFon ttr~ Z1 3J <br /> E�r�Sot tCa 9S Datehh or Check <br /> tt�n=ta! �c <br />